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Participant Registration Form
Attention ALL Participants: Please complete this form in its entirety to participate in Feet
for Seats Fun Run/Walk.
Thank you for Supporting Meadow Brook Theatre!

Feet for Seats 5-K Fun Run/Walk
Sunday, August 23, 2009
On the campus of Oakland University

 


Name:
Email:
Home Address:
City:
Zip Code:
Daytime Phone:
Evening Phone:
Emergency Contact Name:
Phone Number:
T-Shirt Size:

Participant Informed Consent
I am aware that participating in the August 23, 2009 Feet for Seats Fun Run/Walk activities or events, and using the facilities and equipment involve risk of injury, including, but not limited to the range of minor contusions/abrasions to even the possibility of death. I also recognize that there are many other risks of injury including serious disabling injuries, which may arise due to participating, or attending and that is not possible to specifically list each and every individual injury risk. However, knowing and reasonably anticipating that other injuries and even death are a possibility, I hereby expressly assume all of the risks of injury, which could occur, by reason of my voluntary participation in the aforementioned Feet for Seats Fun Run/Walk. I hereby authorize my photograph which was taken by Meadow Brook Theatre and/or Oakland University, its employees, officers, representatives or agents to reproduce my photograph for the purpose(s) of editorial, illustration, advertising, trade or any other publication of MEADOW BROOK THEATRE and/or OAKLAND UNIVERSITY. I release and discharge MEADOW BROOK THEATRE and/or OAKLAND UNIVERSITY from any and all suits, causes of action, claims, demands or obligations of any kind arising out of the reproduction of my photograph for the above stated purposes.

*In order to be guaranteed a t-shirt on the day of the walk – participants must register no later than JULY 15th and must raise $25 or more in sponsor pledges.

* *Registration begins at 8 a.m. on day of event and fun run/walk begins at 9 a.m. - located in the parking lot in front of Meadow Brook Theatre* I hereby acknowledge that I have read and understand the foregoing and intend to be bound thereby.

your completed form via fax to (248) 370-3344, Register Online or Mail to:
Meadow Brook Theatre
Attn.: Feet for Seats
207 Wilson Hall
Rochester, MI 48309-4448
Learn More At: www.mbtheatre.com or www.feetforseats.org